It's a common assumption in health care — and other industries, as well — that improved technology will not only improve processes, but make those processes safer for all involved. With the creation of more robust electronic health records that can be easily shared between providers, advocates say, critical patient information won't be lost in handoffs, and the all-important care continuum will be preserved. On a smaller scale, innovations like computerized physician order entry and bar-coding administration for medications are designed to reduce the risk of human error.
But what if health information technology as a whole is failing to improve overall U.S. patient safety? That tricky question is at the heart of an expansive new report from the Institute of Medicine, which deems the existing literature on the topic to be inconclusive at best and calls for the federal government to take a much larger role in the evaluation and regulation of health IT systems.
While the report notes that CPOE and bar code-assisted medication matching have both been demonstrated to improve patient safety outcomes, it argues that other systems, like electronic health records, have not led to marked improvements in patient safety, while some innovations have even created new safety hazards.
"Dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human-computer interactions or loss of data have led to serious injury and death,” the report notes.
Going forward, the report calls for Congress to create a new, independent entity charged with assessing the links between health IT and patient safety risks. The report also asks the Department of Health and Human Services to establish a mandatory reporting system for "vendors and users to report health IT-related deaths, serious injuries, or unsafe conditions.”
Other recommendations include expanded funding for various groups, such as the Office of the National Coordinator and the Agency for Health Research and Quality, to develop best practices and promote more thorough, pre-deployment safety testing of new systems. If those steps aren't taken, or if progress isn't sufficient, the report recommends that the FDA get involved in the day-to-day business of regulating new health IT systems.
Given the current political and economic climate, it's unlikely the sweeping regulatory changes the IOM is calling for will happen any time soon. But with the IOM's track record for farsightedness — see the lasting impact of "To Err is Human" — it's conceivable that this report will be the first part of a more careful, clear-eyed look at the benefits and hazards of health IT, something the report identifies as absolutely critical.
"Poorly designed health IT can create new hazards in the already complex delivery of care,” the report concludes.
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